System cuts race bias from liver transplants

A scoring system that rates people by how sick they are has eliminated racial disparities that plagued liver transplant waiting lists prior to 2002, researchers at Duke University have found.

Prior to 2002, when the new rating system started at the nation's organ donation programs, time spent on the waiting list was a major factor in deciding who was eligible for a liver transplant. As a result, black patients had comparatively fewer liver transplants than whites, and were at higher risk of dying.

"I think there's potentially a lot of questions about why the racial disparities occurred prior to 2002," said Dr. Cynthia Moylan, a fellow in the division of gastroenterology at Duke. She was a member of the research team that published the study in this week's Journal of the American Medical Association. "One theory is that black patients were getting referred to the list later, when they were sicker, so they couldn't accrue the waiting time."

The new system has eliminated time on the waiting list as a criterion, and instead relies on laboratory tests that prioritize patients based on objective measures of organ function. It began six years ago. Since then, the researchers found, blacks are as likely as whites to get a liver transplant, and have no significantly higher risk of dying while waiting for an organ.

But the study discovered a new disparity -- between men and women. For some reason, Moylan said, women now have a greater chance of dying waiting for a liver transplant than men.

"It's an interesting finding," she said, "but there needs to be more research."